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"Human milk is the preferred feeding for all infants, including premature and sick newborns. It is recommended that breastfeeding continue for at least the first 12 months, and thereafter for as long as mutually desired."

American Academy of Pediatrics Breastfeeding Policy Statement: Breastfeeding and the Use of Human Milk.

TERMS & CONDITIONS

Lactation Consult Consent

  1. The lactation consultant is an allied health care provider and is responsible for evaluating and recommending a care plan to resolve or improve breastfeeding issues.  A lactation visit includes a detailed history of mother/infant, an assessment of maternal/infant anatomy, observation of a feeding for evaluation of technique and effectiveness of feeding, and recommendations for management to improve and/or resolve breastfeeding related issues.  All clients are provided with a written and/or verbal care plan to improve breastfeeding concerns.  The client and the lactation consultant each have responsibilities in this plan.  Resolution of a breastfeeding problem often takes several days or weeks and may require a change in the original recommended care plan at some point.
  2. You are responsible for informing the lactation consultant of changes you feel are necessary in the care plan at the time of the visit or during the course of follow-up communication.  Phone contact after the lactation visit is important and considered an extension of the visit.  Understand it is your responsibility to call the lactation consultant with progress reports, questions or concerns.
  3. Any instructions or recommendations given may be discussed with one or both of your health care providers. 
  4. A partial or follow-up visit is sometimes necessary. Understand that breastfeeding supplies and/or breast pumps may be recommended as effective management of specific situations.  Only effective equipment will be recommended.
  5. The lactation consultant is authorized to release any information acquired in the evaluation and/or management of yourself and/or your child toy our health care providers, referring physician, and/or your insurance company upon request.  The lactation consultant may contact your physician or your child’s physician if necessary.
  6. You will receive a copy of this provider’s Privacy Practices.  (HIPPA Compliance). See Privacy Policy.
  7. Photos and/or videos of your lactation visit may be used for professional education, only with your written consent.

Breastpump Rental Agreement

The agreement for the rental of a Hospital Grade Breastpump and carrying case is made between the Rental Station and the Lessee.

  1. The breastpump remains the property of Hollister/Ameda, Inc. or Medela, Inc.  Lessee has no rights to such breastpump except as expressed in this Agreement.
  2. Lessee may purchase the accessory collection kit to use with the breastpump.  The kit becomes the property of the Lessee and is non-refundable.
  3. Lessee agrees to pay the rental fees.  Rental fees are due in advance.  If Lessee wishes to continue renting the breastpump
    longer than originally agreed, they must call the Rental Station office above and make arrangements for payment to extend the rental.  There is a $25.00 fee for checks returned for insufficient funds.
  4. State Sales Tax will be charged on breastpump rental as well as the collection kit unless a physician’s prescription for a breastpump is provided.
  5. Lessee agrees not to move the breastpump out of this State without the consent of the Rental Station.
  6. Lessee agrees to inform the Rental Station of any change of address or phone number.
  7. Lessee agrees to return the breastpump in clean condition.  If the equipment is not cleaned, Lessee agrees to pay Rental Station a cleaning fee of $25.00.  Window cleaner, 409 or Fantastic can be used to clean the pump and case.
  8. Lessee agrees to return the breastpump in good repair and with all included parts.  If not in good repair, Lessee agrees to pay Rental Station a minimum charge of $30.00.
  9. Lessee shall be responsible for all reasonable legal fees and other costs involved in collection of overdue amounts and recovery of breastpump.
  10. Lessee understands the Rental Station has the right to cancel this agreement at any time with three days notice.
  11. Lessee agrees that their credit card is used as a deposit on the rental breastpump and agrees that the credit card can be charged for the cost of  a new hospital grade breastpump equal to that which was rented if the breastpump is not returned to the Rental Station.  (Hospital Grade Breastpumps range in price from $850.00 to $2100.00.)
  12. Lessee agrees any unpaid balance will be charged to their credit card if not paid in another form when the pump is returned.
  13. Lessee will be given a written receipt for the return of the pump when it is returned to the Rental Station.
  14. This Agreement shall be construed under the laws of the State where the Rental Station is located.
  15. Lessee agrees to allow Rental Station or Hollister/Ameda or Medela or any agency involved in collection of overdue amounts and /or the rental breastpump to obtain a credit report on Lessee. 

Breastpumps (non-rental) and pump parts are considered personal products and are NON-RETURNABLE. Only UNOPENED packages can be returned for exchange.

There is a $25.00 charge assessed for any checks returned for insufficient funds.

All material on this website is provided for educational purposes only. For health concerns regarding issues specific to you or your child, you should consult your health care providers directly.

All images and written materials on this website are copyright or used with permission.
Copyright © 2009, Tidewater Lactation Group, Inc. All rights reserved.

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